经皮经肝胆管穿刺置管引流联合介入治疗老年恶性梗阻性黄疸的疗效观察  

Percutaneous Transhepatic Puncture and Drainage in the Treatment of Malignant Obstructive Jaundice

作　　者：刘炼炼[1] 刘文清[1] 

机构地区：[1]成都军区总医院消化内镜中心,四川省成都市610083

出　　处：《临床合理用药杂志》2013年第6期97-98,共2页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的探讨经皮经肝胆管穿刺置管引流(PTCD)后植入胆管金属支架姑息性治疗老年恶性梗阻性黄疸患者的临床应用价值。方法 40例失去根治性手术机会的65岁以上老年恶性梗阻性黄疸患者先行超声引导下PTCD,再在DSA下经PTCD窦道植入胆管金属支架,将外引流转变为内引流,回顾其支架通畅、胆红素下降、并发症发生等情况。结果 40例患者术前血清总胆红素为(421.6±145.1)μmol/L,术后1周与1个月血清总胆红素分别下降到(183.6±33.4)μmol/L与(144.2±41.5)μmol/L;碱性磷酸酶与丙氨酸转氨酶下降明显。出现并发症12例。生存3～6个月11例,生存超过12个月29例。结论 PTCD联合胆管金属支架置入是一种治疗恶性梗阻性黄疸的有效方法,尤其对于老年患者具有安全、有效、简便、可重复性等优点。Objective To study the biliary stent implantation through sinus by the pereutaneous transhepatic puncture and drainage （PTCD） in the palliative treatment of malignant obstructive jaundice. Methods 40 patients who are 65 years old and lost opportunities for radical surgery with malignant obstructive jaundice were firstly undergone PTCD and secondly the metal stent implantation through PTCD sinus by DSA, which replaced the internal drainage with the external drainage. Results Pre- operative serum total bilirubin was （421.6 ± 145.1） μmol / L, and the level decreased to （ 183.6 ± 33.4） μmol/L and （ 144.2 ±41.5） μmol / L after 1 week and 1 month, respectively. The level of alkaline phosphatase and alanine aminotrans- ferase decreased significantly. Complications found in 12 cases. 11 patients survived for 3 ~ 6 months, and 29 patients survived over 12 months. Conclusion PTCD united with biliary metallic stent implantation is an effective treatment for malignant obstruc- tive jaundice, which is safe, simple and also availble.

关 键 词：经皮经肝胆管穿刺置管引流 黄疸 老年人 治疗结果 

分 类 号：R735[医药卫生—肿瘤]